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Cancer counseling services underused despite documented benefits

Very few cancer patients take advantage of available counseling services, despite a large body of evidence showing such interventions can improve their treatment outcome.

“Given the quality and quantity of cancer support services nationwide, and the positive outcomes of participation shown in the research literature, a high priority should be placed on identifying ways to increase patient use of existing services,” say the study’s co-authors Elizabeth G. Eakin, PhD, and Lisa A. Strycker, MA, of the Oregon Research Institute.

They found that although 68 percent of breast, colon and prostate cancer patients reported being aware of their HMO’s Cancer Counseling Center, only 8 percent used the center. Ninety percent of prostate cancer patients also were aware of a HMO prostate support group, but only 5 percent made use of these services.

The study collected survey responses from 368 cancer patients randomly selected from the rolls of a large Northwest HMO. The investigators also surveyed 29 health care providers. The study will be published in the March issue of Psycho-Oncology.

The main reasons patients gave for forgoing support services were they already had adequate support (32 percent), followed by not knowing the support services existed (25 percent) and not receiving a recommendation from their physician (13 percent).

However, cancer specialists and nurses rated the usefulness of the Cancer Counseling Center very highly, which may explain why they reported referring 70 percent of their patients to the center and estimated that 40 percent of their patients used these services. Physician referral was also a strong predictor for use of the Cancer Counseling Center.

Despite this enthusiasm among health care providers, patients are not getting the message that these services can help them. The researchers suggest that this may be, in part, because of the wide variation in how providers refer patients to these services. While more diligent physicians discuss psychosocial concerns with their patients and describe how counseling can help, other physicians may just include a brochure for the counseling center in a large packet of treatment-related information.

“These findings suggest the need for more systematic ways of educating patients about and providing referrals to cancer support resources. Optimally, a brief psychosocial screening around the time of diagnosis could be conducted as a standard part of treatment for all patients,” the investigators say in the study’s conclusion.

Dr. Eakin is currently working on a senior research fellowship in Australia. The study was supported with funding from the National Cancer Institute.

Psycho-Oncology is a bimonthly international journal devoted to the psychological, social and behavioral dimensions of cancer. Published by John Wiley, it is the official journal of the American, British and International Psycho-Oncology Societies.

Contact Jimmie Holland, MD, Co-Editor, at 212-739-7051 for information.

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